During perimenopause and menopause, uncomfortable symptoms manifest, as a result of declining estrogen, progesterone, and testosterone levels. Hormone Replacement Therapy (HRT) replenishes these crucial hormone levels to re-balance the body, treat symptoms, and restore energy and vitality. Plant-based bioidentical hormones are chemically identical to the hormones the body produces on its own, so HRT is a natural option for addressing symptoms throughout the menopause transition.
Each woman’s experience and symptom profile is different, so a doctor may prescribe estrogen, progesterone, DHEA, or a combination of any of these hormones to address individual needs. The duration of therapy is personal and depends on how a patient responds to treatment. HRT is considered long-term if someone continues treatment for more than five years. Taking HRT long-term has some health benefits, but it’s only appropriate for women if certain health conditions exist.
Long-Term Hormone Replacement Therapy
Although women generally experience perimenopause in their 40s and progress to menopause by around age 50, when to initiate HRT is based on each person’s particular symptoms and health status. Since symptoms are the best indicator for when HRT is needed, a woman can begin HRT as soon as menopause symptoms start to affect daily life.
If you and your doctor decide HRT would benefit you, your doctor will prescribe the lowest dose for the shortest time. Typically, it takes a few weeks to feel the benefits of HRT. Your doctor may recommend a three-month trial, to see if the dosage needs to be adjusted for maximum benefits. You’ll likely be required to schedule follow-ups annually for re-evaluation.
However, there may be instances where taking hormones for an extended time is appropriate. The North American Menopause Society concludes that, barring any health preclusions, women can use hormone therapy beyond the age of 65, if severe menopause symptoms persist.
Benefits of Long-Term HRT
Taking progesterone and estrogen as a continuing therapy may have positive health implications for a woman in the second half of her life.
Diabetes
A research study from Switzerland indicated that estrogen therapy could help prevent diabetes, by helping the pancreas regulate glucose. Another recent study demonstrated that HRT also improved glucose control in women who already had type 2 diabetes.
Osteoporosis
Another advantage of continuing HRT is the reduced risk of developing bone fractures. Osteoporosis is the bone loss that naturally occurs as a woman ages, putting them at a higher risk of broken bones. Menopause accelerates this bone loss, due to the reduction in estrogen. Scientists conclude that HRT can reduce osteoporotic fractures and increase bone mineral density. Other beneficial effects include a 5% greater muscle mass in postmenopausal women on HRT.
Bowel cancers
HRT use impacts colorectal cancer risk. In randomized-controlled trials, HRT bowel cancers are reduced by 38%, indicating that estrogen has a protective effect on the gastrointestinal system.
Cardiovascular health
Estrogen helps decrease the amount of atherosclerosis, or plaque buildup, in the cardiovascular system. As hormones decline during menopause, bioidentical estrogen can help continue this protection against a potential blockage in the heart or blood vessels. A study by the American College of Cardiology demonstrated that women with an average age of 64 years who took HRT had lower atherosclerosis and improved heart health.
While these benefits are attractive to many people, experts caution against taking HRT solely for disease prevention.
Risks of Long-Term HRT
Unfortunately, some women are not candidates for hormone therapy, especially long-term hormone therapy. HRT may put you at risk for serious side effects or exacerbations, if you have certain health conditions. The following conditions in particular can preclude someone from being a good candidate for HRT:
Unexplained abnormal vaginal bleeding
Blood clots
Certain cancers
Uncontrolled high blood pressure
Liver disease
Stroke or heart attack history
If you experience these health conditions, HRT is generally contraindicated because of the potential negative impact. You and your provider can discuss alternative therapies for persistent menopause symptoms.
When deciding when to stop hormone therapy, it’s best to discuss it with your physician thoroughly. Each woman is different, and the risks and benefits of treatment must be individualized, based on her health and medical history and current guidelines.
With a doctor’s recommendation, some women stop taking HRT after menopausal symptoms slowly disappear, which generally spans a period of two to five years. Gradually tapering down the dose or reducing the frequency with which you take HRT is a way to wean yourself off the medication with the fewest side effects. Depending on your dose and type of HRT, it can take 3-6 months to leave your system altogether. You may experience rebound symptoms, such as hot flashes, that will subside over time. Discuss with your doctor how to best stop HRT.
If you and your provider decide to cease HRT for any reason, other remedies exist that can ease the symptoms of menopause.
Vaginal estrogen cream: a topical treatment that relieves vaginal dryness and decreases painful intercourse
Vitamin E: a supplement that helps to manage stress and improve mood
Melatonin: another hormone that declines with age. A melatonin supplement can treat sleep disturbances that may be prevalent during menopause.
Conclusion
Deciding when to start and stop HRT during menopause is based on your symptoms and health status. You and your provider can evaluate if you are a candidate for HRT at any time, or if other remedies may be more appropriate to help you. If you find you are a candidate for long-term HRT, be sure to check with your doctor regularly for re-evaluation.
By taking HRT, you can manage your menopausal symptoms and bring vitality back to your life. Schedule a free consultation with board-certified physicians who can help determine the best solution for you.
